At least one young patient and 15 staff members at Children's Hospital Boston have been diagnosed with whooping cough, the hospital and public health authorities reported yesterday, marking the second time in two months that a Massachusetts hospital has faced an outbreak of the infectious disease.
Sixty other staff members at Children's have symptoms of the bacterial illness and are undergoing blood tests to determine whether they have the condition, said Dr. Anita Barry , top disease tracker at the Boston Public Health Commission . Those workers were sent home until they can finish a five-day course of the antibiotic azithromycin , said Dr. Thomas Sandora , an epidemiologist at Children's.
Letters have been sent to the parents of about 1,000 patients who may have come into contact with potentially infectious staff members, providing information about the disease and directions on what to do if symptoms appear, Sandora said.
"Many of those patients probably weren't exposed, but we're taking a very cautious approach," Sandora said.
It appeared last night that Children's did not follow the law in alerting local health authorities about the outbreak, which began in September, in a timely fashion.
State law requires that suspected cases of many infectious diseases, including whooping cough, be reported to the local board of health within 24 hours of being identified, a measure designed to contain dangerous outbreaks. But the Boston Public Health Commission did not learn about the month outbreak at Children's until Oct. 25, Barry said, and even then the city heard about it indirectly.
"Would I like to hear sooner? Sure. Do I think they're just blowing this off and not taking appropriate action? Certainly not," Barry said. "I think that Children's is really taking this whole thing very seriously."
The state rarely sanctions hospitals or physicians who violate this disease-reporting law.
Hospital and city investigators said they believe the outbreak began after a 19-month-old boy was admitted to the hospital Sept. 21 with a fever, cough, and wheezing. Initially, the child was diagnosed with a disease called respiratory syncytial virus, but because of worsening symptoms, he was sent to intensive care and subsequently diagnosed with whooping cough, also known as pertussis.
From that one case, the outbreak radiated outward, infecting nurses, clinical assistants, and administrative staff members, Sandora said. The toddler has recovered and none of the hospital workers became seriously ill, he added.
Bess Andrews , a spokeswoman for Children's, said last night that hospital representatives had spoken with public health officials in early October about the first case, but that some of the other cases were not reported when the hospital first became aware of them. "It appears we may not be fully compliant with what the notification process is," Andrews said. "We will have to look at our practices and make changes where needed."
Officials at Children's, as well as city and state disease specialists, stressed yesterday that parents should not be concerned about taking their children to the hospital.
"What's important for the public to know is that it's safe to bring their children here," Andrews said.
At St. Vincent Hospital in Worcester, an outbreak in September infected 30 staff members. Officials said they believe a gastrointestinal surgeon who is a military reservist contracted the disease while on duty and unknowingly carried it into the hospital.
Dr. Katrina Kretsinger , medical epidemiologist at the US Centers for Disease Control and Prevention , said one Canadian study had shown that healthcare workers are 1.7 times more likely than the general public to suffer from whooping cough, an increase attributed to their contact with infected patients.
Hospital-based outbreaks, she said, "are fairly common, and they're quite disruptive when they do occur because of the risk of transmitting pertussis to vulnerable patients in the hospital."
Whooping cough is a highly infectious bacterial disease transmitted by coughing and sneezing. Typically, the disease arrives with symptoms similar to those of the common cold. "But then," Barry said, "patients move into the coughing phase, with spasms of coughing."
At its worst, a rattling, rib-cracking cough can linger for months and cause patients to lose sleep and weight. Studies have shown that 62 percent of adults with pertussis are still coughing three months after symptoms appear.
While symptoms can be persistent, the disease rarely kills adults. But it can be deadly in children under 6 months for two pivotal reasons: They have yet to receive a full course of vaccines against the disease, and their immature immune systems may not be sufficient to respond to the infection.
The number of infants dying from the disease, while still small, has been increasing in recent years, Kretsinger said, with 54 deaths between 1980 and 1989, but 92 deaths in the first half of this decade.
Children today routinely get a series of five vaccinations against pertussis. The vaccine's effectiveness wanes within five to 10 years, leaving recipients vulnerable to infection.
In 2005, US health regulators approved the first pertussis booster shot for adults and adolescents, a lower dose than what is given to infants and, thus, less likely to cause adverse effects.
"If we could just get that shot into everybody, we wouldn't be having these problems," said Dr. Alfred DeMaria , the state's director of communicable disease control.
Stephen Smith can be reached at firstname.lastname@example.org.